18.11 


Steell 

... Inaugural  dissertation  on  use  of  Digitalis 

purpurea.  • .  • 
M-RMB66.D4  StS  1811 


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AN 

INAUGURAL  DIS 


UR£L  DISSERTATION 

Cm    THE    USE    OF  .THE       /      .'L^f  /  -  Y^  Jsj/Jjt    f~J 


DIGITALIS    PURPUREA 

IN    THE 

CURE  OF  CERTAIN  DISEASES. 


SUBMITTED  TO   THE  PUBLIC  EXAMINATION 

OF 

SAMUEL  BARD,  M.D.  President 3 

THE 

VICE-PRESIDENT  AND  PROFESSORS 

OF    THE 

COLLEGE  OF  PHYSICIANS 

UNDER  THE  AUTHORITY  OF  THE 

UNIVERSITY  OF  THE  STATE  OF  NEW-YORK, 

FOR  THE  DEGREE  OF 

DOCTOR  OF  MEDICINE, 

On  the  fourteenth  day  of  May,  1811. 

BY  THOMAS  EDWARD  STEELL, 

of  New-Jersey. 


From  facts  and  reason  we  our  precepts  draw 

The  fiim est  basis  of  the  soundest  law  ; 

Whence  nature's  powers  in  fullest  vigour  rise, 

And  fell  disease  with  all  its  phalr.nx  flies.  Darwin. 


$eto4f  orft : 

Printed  by  T.  U  J.  SWORDS,  Printers  to  the  Faculty  of  Physic 
of  Columbia  College.  No.  160  Peari-Street. 


1811. 


TO 


DOCTOR  THOMAS  STEELL, 


THIS 


DISSERTATION 


IS 

MOST  RESPECTFULLY  DEDICATED, 

AS    A 

SMALL  TESTIMONY 

OF 

RESPECT,  GRATITUDE  AND  AFFECTION, 

BY  HIS  SON. 


CONTENTS. 


t  Page. 

Introduction  7 

Section  1.  Description  of  the  Digitalis  Purpurea  12 

2.  The  assignable  Qualities  of  Digitalis  16 

3.  The  Preparations  of  Digitalis  used  IS 

4.  Deductions  from  Experiments  on  Digitalis  20 

5.  Diseases  in  which  Digitalis  has  been  and 

may  be  properly  used  25 

6.  Cases  illustrative  of  the  Principles  de- 

fended in  this  Dissertation  31 


AN 

INAUGURAL  DISSERTATION 


ON   THE   USE    OF    THE 


DIGITALIS  PURPUREA,  &c. 


INTRODUCTION, 

1  HE  wide  difference  in  the  treatment  of  similar 
diseases  in  this  country  and  Great-Britain,  is  sur- 
prising, and  in  some  cases  almost  unaccountable. 

The  same  circumstance  occurs  in  the  employ- 
ment of  particular  remedies  in  certain  classes  of 
disease*  This  observation  applies  with  great  force 
to  the  employment  of  the  digitalis  purpurea.  This 
great  abstractor  of  arterial  action  is  employed  with 
most  advantage  in  acute  diseases  of  high  excite- 
ment in  the  United  States,  the  proof  of  which  will 
be  attempted  in  this  dissertation :  while  its  exhibi- 
tion in  Europe  has  been  confined  to  dropsy,  pul- 
monary consumption,  and  other  diseases  of  de- 
bility. 

Thus  Peruvian  bark  too,  which  we  only  use  in 
the  convalescent  stages  of  disease,  has  been  found 
serviceable  in  England  in  the  inflammatory  stage 

2 


(    8    } 

of  acute  rheumatism.*  My  own  observations 
would  prompt  me  to  reject  such  practice,  and  this 
opinion  is  confirmed  by  Dr.  Miller's  observations 
and  trials  in  the  New- York  Hospital,  in  the  winters 
of  1807**8,  where  several  cases  happened  in  which 
fair  experiments  demonstrated  the  impropriety  of 
the  practice. 

Climate,  soil,  government,  and  other  causes 
operate  in  producing  a  difference  in  the  symptoms 
of  diseases  and  their  consequent  treatment.  These 
no  doubt  have  their  full  operation*  But  there  is 
another  cause  that  affects  nations  as  opinions  do  in- 
dividuals. Hence  arises  a  national  practical  preju- 
dice, if  we  may  so  call  it.  Dr.  Rush  observes, 
that  "  whole  nations  are  as  much  distinguished  by 
it  as  they  are  by  language  and  manners.  In  Eng- 
land, cordial  and  sweating  medicines ;  in  France, 
bleeding,  injections,  and  diluting  drinks ;  in  Ger- 
many, alterative  medicines;  in  Italy,  cups  and 
leeches;  in  Russia,  hot  and  cold  baths;  and,  in 
China,  frictions,  constitute  the  predominating  and 
fashionable  remedies  in  all  their  respective  dis- 
eases, "f 

Universities  tend  to  establish  such  opinions  and 
practice  when  they  do  not  allow  that  liberal  discus- 
sion  and  expression  of  sentiment  which  is  pecu- 
liar to  the  government  and  medical  institutions  of 
the  United  States.  National  ideas  may  thus  con- 
tribute to  the  adoption  of  digitalis  in  opposite  dis- 
eases.   Be  this  as  it  may ;  it  is  intended  in  this  dis- 


*  Notes  on  Dr.  Miller's  Clinical  lectures. 

f  Six  Introductory  Lectures,  published  in  Philadelphia,  1801- 


(     9     ) 

sertation  to  establish,  by  practical  observations  and 
facts,  the  proper  use  of  digitalis.  This  will  be 
found  in  the  free  use  of  it  in  inflammatory  diseases, 
or  those  which  are  occasionally  attended  with 
symptoms  of  excitement,  but  are  generally  dis- 
eases of  debility.  I  would  agree  with  Dr.  Quin* 
in  the  use  of  digitalis  in  hydrocephalus,  as  that  is 
truly  a  disease  of  excitement,  f 

Did  national  opinions  introduce  the  improved 
treatment  of  parturient  women  into  the  United 
States  ?  We  are  greatly  indebted  to  Dr,  Archer,J 
of  Maryland,  and  Dr.  Dewees,§  of  Philadelphia, 
for  the  depleting  system  which  is  now  generally 
pursued  here  with  success.  In  the  British  practi- 
cal works  (which  have  generally  been  our  text 
books)  on  midwifery,  many  pages  are  generally 
taken  up  with  accounts  of  puerperal  fever,  ||  while, 
by  the  American  treatment  of  lying-in  women,  this 
disease  is  almost  exterminated.  While  stimulant 
diet  and  drinks  were  slaying  their  thousands,  these 
same  authors  were  disputing  the  origin  and  nature 
of  the  disease.  I  have  been  informed  by  a  person 
who  attended  Dr.  Dewees's^f  lectures  on  mid- 
wifery, that  of  the  great  number  of  patients  deli- 
vered by  him,  three  only  had  been  attacked  by 
puerperal  fever,   and  these  by  the   obstinacy  of 


*  Quin  on  Dropsy  of  the  Brain. 

f  Rush's  Med.  Inquiries. 

$  See  Med.  Repos.  vol.  i.  p.  323. 

§  Dewees's  Inaug.  Dissert.  Phila.  1806. 

||  Denman,  White,  Leake,  &c. 

•ff  Dr.  Dewees  practised  a  number  of  years  In  the  city  of  Philadelphia, 
and  after  giving  several  courses  of  private  lectures  on  midwifery,  pub- 
lished a  practical  inaugural  dissertation,  illustrated  by  most  important 
cases. 


(     10    ) 

nurses,  who  refused  to  attend  to  his  directions  rer 
specting  diet.  If  digitalis  was  used  in  cases  of 
parturition,  where  bleeding  would  be  serviceable, 
might  we  not  do  it  with  less  ease  and  more  cer- 
tainty, particularly  in  those  instances  where  oppo- 
sition arises  from  fear  or  prejudice,  or  the  interfer- 
ence of  friends  ? 

I  would  observe  further,  that  the  aphthous  state 
of  fever  requires  also  in  the  United  States  a  me- 
thod of  treatment  different  from  that  which  it  re- 
ceives in  Great-Britain.  Instead  of  depending  on 
an  undue  share  of  alkalescency  in  the  blood,  or 
other  humours  of  the  system,  it  is  generally  marked 
by  the  predominance  of  an  acid,  at  least  in  the  ali- 
mentary canal,  and  particularly  in  the  alimentary 
canal  of  children.  Hence  the  good  effects  derived 
from  the  exhibition  of  salt  of  tartar,  magnesia,  and 
other  absorbents,  considered  in  the  light  of  mere 
local  remedies. 

The  opinions  of  physicians  respecting  the  use  of 
digitalis,  differ  as  widely  as  their  practice,  or  the 
experiments  and  cases  produced  to  prove  the  par- 
ticular efficacy  of  its  virtues.  It  was  formerly  con- 
sidered, and  I  believe  properly,  as  a  sedative,  an 
abstractor  of  stimulus  or  excitement.  Of  late 
years,  however,  it  has  been  considered  as  an  exr 
citor,  and  applied  accordingly.  I  am  in  hopes  to 
show  this  to  be  a  fallacious  result  of  partial  obser- 
vation and  experiment.  I  find,  however,  by  my 
inquiries  among  physicians  of  this  place,  that  a 
majority  of  them  are  friendly  to  my  sentiments  on 
this  subject.  Analogical  reasoning,  correct  in  many 
instances,  but  fallacious  in  more,  when  applied  to 


(  11  ) 

medical  subjects,  has  been  employed  to  prove 
digitalis  a  stimulant.  It  has  been  compared  to 
opium  in  its  effects,*  and  the  inference  has  appa- 
rently been  a  fair  one.  Dr.  Moore  says,  "  Let  us 
take  a  short  view  of  their  similar  effects  on  the  liv- 
ing system.  Opium  increases  the  frequency  and 
fulness  of  the  pulse ;  digitalis  very  frequently  does 
the  same.  Opium  produces  sometimes  an  in- 
creased flow  of  saliva ;  so  will  digitalis.  Opium 
produces  profuse  perspiration ;  one  of  the  patients 
in  the  Alms-house  who  took  digitalis,  had,  for 
the  first  three  or  four  days,  more  copious  per- 
spiration than  before.  Opium  is  sometimes  a 
diuretic ;  this  is  one  of  the  most  prominent  effects 
of  digitalis.  Who  has  not  in  some  instances  seen 
opium  prove  laxative?  Digitalis  purged  in  se- 
veral of  the  experiments  when  I  gave  it  to  the 
healthy  subject.  Opium  in  a  large  dose  produces 
vertigo,  confused  vision,  thirst,  and  stertorous  re- 
spiration; the  same  effects  follow  large  doses  of 
digitalis.'* 

This  is  Dr.  Moore's  view  of  the  subject  touch- 
ing that  point.  In  this  account  he  has  compared 
constant  effects  with  accidental  circumstances. 
Were  I  to  compare  their  effects,  this  should  be 
my  statement:  Opium  has  a  stimulant  effect,  so 
has  digitalis ;  but  that  of  opium  is  much  more  last- 
ing. The  stimulant  effect  of  opium  is  also  much 
greater  than  that  of  digitalis.  The  specific  effect 
of  opium  is  more  certain  than  that  of  digitalis. 
The  secondary  effects  of  opium  and  digitalis  are 

?  See  Moore  on  Digitalis,  in  Caldwell's  Medical  Theses,  1805,  p. 205. 


(     12    ) 

widely  different,  the  former  being  more  lasting. 
In  large  doses  they  produce  effects  apparently  si- 
milar, but  really  different 

The  want  of  analogy  between  these  two  articles 
of  the  Materia  Medica  will  be  still  more  evident 
by  what  follows.  Opium  cannot  be  used  in  the 
cure  of  inflammatory  diseases  till  the  febrile  symp- 
toms have  subsided,  and  then  in  many  cases  it  is 
unnecessary ;  but  where  it  is  necessary  it  acts  as 
a  cordial  in  reviving  the  spirits  and  giving  strength. 
Digitalis  may  be  given  with  a  direct  contrary  effect. 
It  will  reduce  febrile  excitement,  and  is  dangerous 
in  the  debility  of  convalescents ;  for  though  it  at 
first  increases  the  number  of  arterial  pulsations, 
it  afterwards  diminishes  them  in  a  greater  ratio  than 
the  increase,  according  to  the  time.  A  parallel  of 
this  kind  might  be  lengthened,  if  it  would  lead  to 
the  desired  certainty  of  the  operation  of  digitalis ; 
but  I  shall  proceed  to  a  less  diffuse  consideration 
of  the  subject. 


SECTION  I. 

Description  of  the  Digitalis  Purpurea. 

The  digitalis  purpurea  is  an  European  plant,  a 
native  of  Great-Britain,  where  it  grows  by  the  road 
sides  and  along  the  hedges,  but  on  account  of  its 
beauty  and  medical  qualities,  has  become  an  or- 
namental garden  plant.  It  has  been  introduced  into 
the  United  States,  and  lost  none  of  its  virtues  by 
transportation.    In  Linnseus's  system  of  botany  it 


(  13  ) 

is  arranged  under  the  class  didynamia  and  order  an- 
giospermia.  Since  the  plant  is  well  known,  and 
has  often  been  described,  my  limited  knowledge  of 
botany  will  be  an  excuse  for  the  following  account, 
taken  from  Dr.  Woodville's  celebrated  work  on 
medical  botany.* 

"  The  root  is  biennial,  branched,  and  fibrous ; 
the  stalk  is  erect,  simple,  tapering,  covered  with 
fine  hairs  or  down,  and  rises  commonly  to  the 
height  of  four  or  five  feet;  the  leaves  are  large, 
oval,  narrowed  towards  the  points,  obtusely  ser- 
rated, veined,  downy,  and  stand  upon  short- winged 
footstalks;    the  flocal  leaves,   or  bractea,  spear- 
shaped,  sessile,   purplish  towards  the  point;   the 
calyx  consist  of  five  segments,  which  are  eliptical 
pointed,  nerved,  or  ribbed,  and  the  upper  segment 
is  narrower  than  the  others ;  the  flowers  grow  in  a 
long  terminal  spike,  chiefly  on  one  side ;  they  are 
large,  monopetalous,  pendulous,  bell- shaped,  pur- 
ple, and  marked  on  the  inside  with  little  eyes,  or 
dark  coloured  dots,  placed  in  whitish  rings ;  the  tu- 
bular part  appears  inflated,  and  almost  cylindrical, 
but  swelling  towards  the  base,  and  opening  at  the 
limb  into  four  irregular,  short,  obtuse  segments;  of 
these  the  uppermost  is  the  shortest,  appearing  trun- 
cated, or  cut  off  transversely ;  the  peduncles  are 
round,  short,  villous,  and  bend  downwards  by  the 
weight  of  the  flowers ;  the  filaments  are  two  long, 
and  two  short,  white,  crooked,  inserted  in  the  bot- 
tom of  the  tube,  and  crowned  with  large,  oval,  yel- 
low antherse;  the  style  is  simple,  and  thickening 

*  Vol.  i.  p.  71.  4to.  London.  1790, 


(     14    ) 

towards  the  stigma,  which  is  bifid ;  the  germen  is 
oval,  and  surrounded  at  the  bottom  by  a  small 
nectarious  gland ;  the  capsule  is  bilocular,  and  con- 
tains many  blackish  seeds.  It  grows  commonly 
about  road  sides  and  hedges,  especially  in  dry 
gravelly  soils,  and  flowers  in  June  or  July." 

"  The  leaves  of  foxglove  have  a  bitter  nauseous 
taste,  but  no  remarkable  smell;  they  have  been 
long  used  externally  to  sores  and  scrophulous  tu- 
mours, with  considerable  advantage.  Respecting 
the  internal  use  of  this  plant,  we  are  told  of  its 
good  effects  in  epilepsy,  scrophula,  and  phthisis; 
but  the  incautious  manner  in  which  it  was  em- 
ployed rendered  it  a  dangerous  remedy ;  thus  we 
find  Ray  (after  reciting  the  case  of  epilepsy  cured 
by  it,  as  mentioned  by  Parkinson)  says,  '  Verum 
medicamentum  hoc  robustioribus  tantum  con- 
venit  sequidum  violanta  admodum  purgat,  et  vo- 
mitiones  immanes  excitat:'  and  others,  speaking 
of  its  successful  exhibition  in  scrophula,  re- 
mark, *  Sed  ob  nemiam  remedii  vehementiam  con- 
tinuationem  ejus  necessarium  detrectavit.'  Yet 
while  digitalis  was  generally  known  to  possess 
such  medical  activity,  its  diuretic  effects,  for 
which  it  is  now  deservedly  received  in  the  Ma- 
teria Medica,  were  wholly  overlooked ;  that  to  this 
discovery  Dr.  Withering  has  an  undoubted  claim, 
and  the  numerous  cases  of  dropsy  related  by  him 
and  other  practitioners  of  established  reputation, 
afford  incontestible  evidence  of  its  diuretic  powers, 
and  of  its  practical  importance  in  the  cure  of  those 
diseases.  From  Dr.  Withering's  extensive  expe- 
rience of  the  use  of  digitalis  in  dropsies,  he  has 


(    15    ) 

been  enabled  to  judge  of  its  success  from  the  fol- 
lowing circumstances: — It  seldom  succeeds  in  men 
of  great  natural  strength,  of  tense  fibre,  of  warm 
skin,  of  florid  complexion,  or  in  those  of  a  tight  and 
cordy  pulse.  If  the  belly  in  ascites  be  tense,  hard, 
and  circumscribed,  or  the  limbs  in  anasarca  solid 
and  resisting,  we  have  but  little  hope.  On  the 
contrary,  if  the  pulse  be  feeble,  or  intermitting, 
the  countenance  pale,  the  lips  livid,  the  skin  cold, 
the  swollen  belly  soft  and  fluctuating,  the  anasar- 
cous  limbs  readily  pitting  under  the  pressure  of  the 
finger,  we  may  expect  the  diuretic  effects  to  follow 
in  a  kindly  manner."  Of  the  inferences  which  he 
deduces  the  fourth  is,  "  that  if  it  (digitalis)  fails 
there  is  but  little  chance  of  any  other  medicine 
succeeding."  Thus  we  are  to  infer,  that  men  of 
great  natural  strength,  and  under  the  other  circum- 
stances just  mentioned,  when  affected  with  dropsy, 
have  little  to  hope  for  from  this  diuretic,  and  still 
less  from  any  other  medicine.  As  this  observation 
is  the  result  of  experience,  and  of  considerable 
practical  consequence,  we  wish  particularly  to  press 
it  on  the  attention  of  the  medical  reader.  Although 
the  digitalis  is  now  generally  admitted  to  be  a  very 
powerful  diuretic,  and  many  cases  may  be  adduced 
of  its  successful  use,  in  addition  to  those  already 
published,  yet  it  is  but  justice  to  acknowledge  that 
this  medicine  has  more  frequently  failed  than  could 
have  been  reasonably  expected  from  a  comparison 
of  the  facts  stated  by  Dr.  Withering. 

"  The  dose  of  the  dried  leaves  in  powder  is  from 
one  grain  to  three  twice  a  day.  But  if  a  liquid  me- 
dicine is  preferred,  a  drachm  of  the  dried  leaves  is 

3 


(     16    ) 

to  be  infused  for  four  hour?  in  half  a  pint  of  boiling 
water.  One  ounce  of  this  infusion  given,  twice  a 
day,  is  a  medium  dose.  It  is  to  be  continued  in 
these  doses  till  it  acts  upon  either  the  kidnies,  sto- 
mach, the  pulse  (which  it  has  a  remarkable  power 
of  lowering),  or  the  bowels." 


SECTION  II. 

The  assignable  Qualities  of  Digitalis. 

Having  given  a  description  of  the  plant  from 
whence  our  medicine  is  derived,  and  in  which 
some  of  its  medical  qualities  are  mentioned,  we 
shall  now  proceed  to  notice  other  qualities  ascribed 
to  it,  and  examine  into  their  several  merits. 

"  Its  effects  when  swallowed  are, 

"  1st.  To  diminish  the  frequency  of  the  pulse. 

"  2d.  To  diminish  the  irritability  of  the  system. 

"  3d.  To  increase  the  action  of  the  absorbents. 

"•  4th.  To  increase  the  discharge  by  urine."* 

"  1st.  To  dimmish  the  frequency  of  the  pulse." 
This  first  great  point  being  ascertained,  establishes 
the  most  important  view  of  the  subject  to  which 
I  would  particularly  invite  attention,  since  this 
alone  would  render  it  a  most  powerful  auxiliary 
to  the  cure  of  many  diseases  in  the  hands  of  the 
medical  practitioner.  My  particular  view  of  the 
subject  will  tend  to  establish  this  point  more 
clearly,  both  by  experimnts,  and  by  cases    which 

*  Coxe's  American  Dispensatory. 


(    17    ) 

will  accord  with  deductions  made  from  those  ex- 
periments. From  this  power  of  digitalis  on  the 
pulse,  it  might  properly  be  given,  first,  in  inflam- 
matory diseases,  and,  second,  in  active  hemorr- 
hages. 

"  2d.  To  diminish  the  irritability  of  the  system." 
On  the  power  which  digitalis  possesses  over  the 
pulse,  in  all  probability  depends  its  power  of  di- 
minishing irritability,  by  first  diminishing  excite- 
ment. Hence  in  may  be  useful,  first,  in  many 
cases  of  mania ;  second,  in  delirium,  particularly 
that  attending  diseases  of  high  excitement 

"  3d.  To  increase  the  action  of  the  absorbents." 
If  we  could  rely  upon  its  uniform  effects  upon  the 
absorbent  system,  its  use  in  scrophula,  dropsy, 
and  phthisis  would  be  much  more  certain. 

"  4th.  To  increase  the  discharge  of  urine."  The 
diuretic  effects  of  digitalis  is  doubtful  and  uncer- 
tain, at  least  in  a  sufficient  degree,  both  as  to  ex- 
tent and  uniformity  to  make  it  an  efficient  remedy 
in  dropsical  diseases.  Granting,  however,  that  it 
may  be  diuretic,  its  power  over  the  pulse  will  add 
one  and  subtract  two,  except  in  certain  cases,  as 
will  hereafter  be  mentioned.  But  its  diuretic  ef- 
fects, as  far  as  our  experiments  prove,  are  trifling 
and  precarious.  This,  however,  is  anticipating  the 
subject. 

Dr.  Withering  has  the  credit  of  first  making 
known  the  diuretic  powers  of  digitalis,  and  his  sub- 
sequent practice  would  confirm  the  apparent  fact. 
Great  names  carry  great  weight  in  their  favourite 
opinions.  The  established  character  of  Dr.  Wi- 
thering gave  his  opinions  currency.    Now  it  seems 


(     18     ) 

he  either  conceived  or  discovered  that  diuresis  fol- 
lowed its  use  ;  hence  the  bent  of  his  practice  went 
to  prove  this  point.  The  opinions  and  deductions 
that  I  have  made  from  the  use  of  digitalis,  arose 
from  reflecting  on  its  power  over  the  pulse,  and 
having  cases  presented  for  consideration.  Perhaps, 
as  I  have  before  observed,  there  may  be  some  dif- 
ference between  the  constitutional  effects  of  the  at- 
mosphere of  this  country  and  Great-Britain.  But 
Dr.  Lettsom,  of  London,  failed  with  digitalis  in 
dropsy,  according  to  Dr.  Withering's  plan.*  I 
am  hence  inclined  to  trust  more  to  the  two  first 
qualities  which  are  ascribed  to  digitalis,  than  to  the 
others,  as  the  foundation  of  correct  practice  with 
this  medicine. 


SECTION  III. 

The  Preparations  of  Digitalis  used. 

It  belongs  to  the  Materia  Medica  to  accommo- 
date remedies  to  the  taste  of  the  patients,  in  order  or 
meet  prejudice,  age,  habit,  antipathy,  and  the  like. 
Hence  arise  the  different  preparations  of  tinctures, 
decoctions,  infusions,  syrups,  pills,  powders,  &c. 

Digitalis  has  been  generally  conveyed  in  one  of 
the  four  following  forms,  viz.  in  substance,  in 
tincture,  in  infusion,  or  in  decoction. 

1st.  In  substance.  The  most  effectual  mode  of 
prescribing  digitalis  is  in  pill  or  powder.    In  either 

*  See  Memoirs  of  the  Medieal  Society  of  London,  vol.  ii.  p.  145. 


i    19   ) 

of  these  forms  it  may  be  given  to  the  quantity  of 
one,  two,  or  more  grains,  twice  or  oftener  in  a 
day,  according  to  the  elevation  of  the  pulse  and 
the  urgency  of  the  febrile  symptoms.  From  the 
vertigo,  nausea,  and  vomiting  which  large  doses, 
three  grains  and  upwards,  produce,  it  would  be 
adviseable,  if  the  case  require  it,  to  give  two  grains 
and  under  at  a  dose,  and  repeat  it  several  times 
a  day.  In  some  cases,  two  grains  may  safely  be 
given  four  times  a  day,  and  one  grain  six  times 
and  oftener.  A  careful  observation  of  the  pulsej 
however,  should  regulate  the  frequency  of  the  re- 
petition. 

The  preparation  of  the  powder  of  digitalis  is 
easy  and  simple,  and  should  be  known  by  every 
one  who  wishes  the  true  unadulterated  drug.  It 
growing  in  dry  gravelly  soils,  is  easily  cultivated, 
the  mature  leaves  of  the  plant  being  collected, 
it  should  be  dried  gradually  by  a  gentle  fire ;  but 
least  the  heat  should  dry  it  too  hastily,  and  evapo- 
rate too  much  of  its  moisture,  it  might  be  dried 
by  the  heat  of  the  sun  with  more  advantage.  The 
middle  stalk  of  the  leaf  should  be  rejected,  and, 
when  dried,  it  is  easily  reduced  to  a  fine  powder. 

2d.  In  tincture.  Digitalis  may  be  given  in  this 
form  to  the  amount  of  five,  ten,  or  even  fifty  drops 
three  times  a  day,  to  an  adult.  Like  all  other  me- 
dicines, when  the  system  becomes  accommodated 
to  its  action,  it  may  be  gradually  increased.  The 
following  is  the  most  adviseable  mode  of  preparing 
the  tincture :  Digest  one  ounce  of  the  dried  leaves 
in  eight  ounces  of  diluted  alkohol  for  seven  days, 
then  strain  it  through  paper. 


(    20     ) 

3d.  In  infusion.  An  ounce  of  the  infusion  of 
digitalis  may  be  given  from  twice  to  four  times  a 
day — two  ounces  daily — make  a  medium  dose, 
and  will  hence  be  diminished  or  increased,  as  cir- 
cumstances require.  It  is  made  by  pouring  eight 
ounces  of  boiling  water  on  a  drachm  of  the  dried 
leaves,  and  letting  it  stand  for  several  hours. 

4th.  In  decoction.  Boiling  extracts  the  active 
qualities  of  substances  much  sooner  than  either 
spirit  or  cold  water.  Hence  the  expediency  of 
administering  decoctions  when  the  urgency  of  the 
case  requires  expedition,  and  the  medicine  must 
be  conveyed  in  a  liquid  form.  A  drachm  of  the 
leaves  of  digitalis  may  be  boiled  in  ten  ounces  of 
water  till  reduced  to  eight.  An  ounce  of  this  is  a 
dose  for  an  adult,  repeated  thrice  or  oftener  in  a 
day. 


SECTION  IV. 

Deductions  from  Experiments  on  Digitalis. 

My  opinions  of  the  operation  of  digitalis  are  de- 
duced from  its  effects  on  the  pulse.  I  was  about 
to  institute  a  set  of  experiments  for  the  purpose  of 
ascertaining  this  point,  when  some  already  made 
occurred  to  me,  which  will  verify  my  ideas  on  the 
subject,  though  they  were  made,  and  have  been 
used  to  substantiate  an  opposite  opinion,  viz.  that 
digitalis  is  a  stimulus.  These  experiments,  when 
properly  analyzed,  together  with  the  cases  which 
shall  hereafter  be  presented,  will,  it  is  hoped,  place 


(    21     ) 

the  operation  of  this  medicine  in  a  clear  point  of 
view,  and  remove  every  objection  to  its  employ- 
ment in  diseases  of  excitement.  The  experiments 
alluded  to  are  to  be  found  in  Dr.  Moore's  Inaugu- 
ral Dissertation.*  Such  of  these  experiments  as 
time  has  allowed  me  to  repeat,  have  terminated 
with  a  similar  result.  They  were  made  with  digi- 
talis officinally  prepared.  The  first  operation  was 
in  most  cases  to  increase  the  number  of  pulsations 
for  a  few  minutes,  but  afterwards  to  diminish  them 
in  a  greater  ratio. 

When  experiments  are  made  with  any  particular 
view,  every  thing  else  is  kept  entirely  out  of  sight, 
and  the  experimenter  is  irresistibly  led  to  the 
wished  for  result.  Least  on  this  account  I  might 
be  led  to  false  conclusions,  I  have  omitted  my  own 
experiments,  and  taken  those  of  Dr.  Moore  as  the 
ground- work  of  my  reasoning :  For  this  purpose  I 
have  made  the  following  analysis  of  his  experi- 
ments: 

Analysis  of  Dr.  Moore's  Experiments. 

Exp.  1. — One  grain  of  powdered  digitalis  was 
taken  with  the  pulse  at  72  pulsations  in  a  minute. 
In  35  minutes  it  rose  to  78,  and  from  thence  fell 
63  pulsations  per  minute,  in  85  minutes.  Thus 
one  grain  raised  the  pulse  six  beats  in  thirty-five 
minutes,  and  reduced  twelve  beats  below  its 
standard,  or  eighteen  below  its  artificial  elevation. 
in  eighty-five  minutes. 

*  See  Caldwell's  Medical  Theses,  1805. 


(     22     } 

Exp.  2 — This  experiment  is  not  given  with  the 
same  detail  as  the  preceding  and  following,  though 
the  result  is  similar,  and  is  therefore  omitted. 

Exp.  3. — Three  grains  of  digitalis  were  taken 
with  the  pulse  at  60,  its  natural  healthy  standard. 
In  thirty  minutes  it  was  reduced  to  54,  without 
previous  elevation.  From  thence  it  varied  between 
50  and  60  beats  a  minute,  until,  as  the  author 
himself  expresses,  (upon  whom  the  experiment 
was  made)  "  in  two  hours  the  nausea  was  so  great 
that  it  was  with  difficulty  I  could  avoid  vomiting, 
and  my  pulse  did  not  appear  (for  it  was  not 
counted)  to  be  more  than  forty  strokes  in  a  mi- 
nute." 

Exp.  4. — -Forty  minutes  after  taking  three  grains 
of  digitalis,  Dr.  Enoch  Wilson  had  his  pulse  raised 
from  66  to  72  pulsations  in  a  minute ;  but  in  85 
minutes  more  it  was  reduced  from  72  to  58. 
.Here  was  an  increase  of  six  pulsations  in  the  space 
of  40  minutes,  and  a  decrease  of  eight  below  its 
standard,  or  fourteen  below  its  artificial  elevation, 
in  85  minutes. 

Exp.  4. — Four  grains  of  digitalis  raised  the 
pulse  four  beats  in  15  minutes,  and  from  thence 
it  varied,  till  in  65  minutes  it  regained  its  standard, 
which  was  diminished  in  strength.  Observations 
on  the  pulse  were  no  longer  continued.  The  fur- 
ther consequence  of  this  dose  was  to  produce 
vertigo,  nausea,  sleepiness,  three  dejections,  and 
sensations  similar  to  those  following  a  drunken  de- 
bauch. 

Exp.  6. — To  a  black  man  six  grains  of  digitalis 
were  given  with  a  pulse  of  90  beats.    In  two  hours 


{    23    ) 

it  was  reduced  to  70,  without  previously  raising  it. 
Sleepiness,  nausea,  pain  in  the  stomach,  and  then 
in  the  bowels,  followed  its  exhibition.  "  I  gave 
digitalis  (says  Dr.  Moore)  to  the  same  man  several 
times,  in  similar  doses,  with  exactly  the  same 
effects,  only  in  a  more  moderate  degree :  it  did  not 
in  any  instance  raise  the  pulse  above  the  natural 
standard." 

Exp.  7. — Three  grains  of  digitalis  raised  Dr. 
E.  Willson's  pulse  from  60  to  72  beats  in  fifty 
minutes.  It  returned  to  60  in  two  hours,  beyond 
which  no  observation  was  made. 

Exp.  8.— By  three  grains  of  digitalis  the  pulse 
was  raised  eighty  beats  in  fifteen  minutes,  and  re- 
duced ten  in  fifty-eight  minutes. 

These  experiments,  and  other  similar  ones  made 
by  myself,  prove  two  things :  first,  that  digitalis, 
in  many  instances,  increases  the  number  of  pulsa- 
tions for  a  limited  time ;  and,  second,  that  a  de- 
pression then  takes  place  to  a  greater  degree. 
Without  further  observation  we  are  immediately 
led  to  this  conclusion,  that  the  sedative  effect  of 
digitalis  is  greater  than  its  stimulant,  since  the 
latter  is  limited,  less,  and  not  so  permanent. 

That  the  stimulant  effect  of  digitalis  is  limited 
may  be  seen  by  the  pulse  gaining  its  maximum  of 
pulsations  in  forty  or  fifty  minutes,  and  even  some- 
times in  fifteen  (Exp.  5th  and  8th).  It  is  also  less, 
for  by  the  first  experiment  the  pulse  was  raised  six 
beats,  and  diminished  twelve  below  the  standard : 
by  the  fourth  it  was  raised  six,  and  diminished 
eight ;  by  the  eighth  it  was  increased  eight  beats, 
and  diminished  ten. 

4 


(    24    ) 

The  fifth  and  seventh  experiments  differ  in  their 
results  from  the  others,  for  in  these  the  number  of 
pulsations  was  only  increased,  and  their  maximum 
was  induced  in  a  short  time.  On  the  other  hand, 
however,  the  third  and  sixth  experiments  are  more 
striking,  as  a  diminution  of  the  pulsations  took 
place,  and  did  not  gain  their  minimum  in  two  hours 
more,  besides  being  accompanied  by  those  effects 
which  attended  the  other  experiments,  viz.  vertigo, 
nausea,  &c.  which  are  generally  reducers  of  arte- 
rial action. 

The  greater  permanency  of  the  sedative  or  de- 
pressing effect  of  digitalis  should  mark  its  character 
among  the  articles  of  the  Materia  Medica.  In  all 
the  experiments  in  which  the  pulse  was  first  ele- 
vated and  then  depressed,  notwithstanding  the  pulse 
gained  its  maximum  of  elevation  in  less  time  than 
it  arrived  at  its  minimum  of  depression,  yet,  the 
ratio  of  decrease  was  greater  than  the  increase. 

If  we  take  the  first  experiment  it  will  be  proved 
thus:  The  pulse  was  raised  six  strokes  in  35 
minutes,  and  then  depressed  eighteen  in  85  mi- 
nutes. Thus,  then,  as  35  :  6 : :  85  :  14*57 ;  that 
is  to  say,  according  to  the  ratio  of  the  increasing 
pulsations,  the  diminished  number  ought  to  be 
14*57,  for  the  time  given,  instead  of  the  real  num- 
ber 18. 

The  ratio  will  not  be  the  same  in  the  other  ex- 
periments, but  still  it  will  exceed  the  ratio  of  in- 
creasing pulsations. 

Here  then,  we  find,  that  by  a  partial  view  of  the 
subject  Dr.  Moore  has  been  led  into  an  error,  in 


(    25     ) 

order  to  confirm  the  opinion  of  his  professor  (Dr. 
Barton*)  that  digitalis  is  a  stimulant,  f 

From  what  has  been  said  we  may  make  the  fol- 
lowing general  deductions,  viz.  First,  that  digitalis 
has  a  sudden  effect  in  elevating  the  pulse,  that  the 
depression  which  follows  may  have  a  greater  effect, 
in  as  much  as  it  is  in  a  greater  ratio.  Second,  that 
its  use  may  be  extended  to  all  diseases  where  there 
is  a  high  febrile  excitement,  and  where  the  pulse 
requires  reduction  in  the  number  of  its  pulsations, 
or  in  tension  or  hardness. 


SECTION  V. 

Diseases  in  which  Digitalis  has  been  and  may  be 
properly  used. 

From  the  preceding  view  of  the  subject,  and  the 
deductions  made  therefrom,  it  is  very  easily  known 
in  what  cases  digitalis  has  been  properly  used,  or 
may  be  used  with  any  prospect  of  success.  It  is 
therefore  only  necessary  to  name  the  disease,  and 
the  propriety  or  impropriety  of  making  digitalis 
the  basis  of  a  prescription  will  be  evident.  I  have 
known  it  to  be  administered  in  pneumonia,  acute 
rheumatism,  pulmonary  consumption,  hemoptysis, 
and  the  various  species  of  dropsy,  &c.     The  use 

*  Professor  of  Materia  Medina  and  Botany  in  the  University  of  Penn- 
sylvania. 

'  f  Should  Dr.  Moore  ever  meet  with  this  free  expression  of  my  senti- 
ments, I  hope  he  will  not  consider  it  illiberal.  I  had  commenced  this 
view  of  the  subject  previous  to  my  seeing  his  dissertation,  and  am  con- 
vinced of  its  correctness  from  this  examination  of  his  experiments,  and 
xhe  cases  accompanying  this  view. 


(    26    ) 

of  digitalis  has  been  sanctioned  in  these  several 
diseases,  but  its  success  in  them  has  been  by  no 
means  uniform ;  repeated  failures,  therefore,  render 
a  more  particular  examination  necessary. 

Pneumonia. 

From  the  general  principle  which  has  been  esta- 
blished, it  will  be  naturally  concluded  that  the  use 
of  digitalis  is  correct  both  in  pneumonia,  peripneu- 
monia, and  pneumonia  pluritis.  In  these  instances 
then  we  are  guided  by  the  correctness  of  the  prin- 
ciple. Accordingly  this  medicine  would  not  be 
given  to  the  emaciated  convalescent,  still  confined 
by  debility;  nor  would  it  be  deemed  proper  in  the 
typhoid  state  of  pneumonia.  The  correctness  of 
this  practice  is  likewise  confirmed  by  the  cases 
which  will  presently  meet  the  reader's  attention. 

Rheumatismus. 

Correct  cases  will  be  detailed  to  establish  the  pro- 
per use  of  digitalis  in  this  disease,  but  it  is  only  in 
the  febrile  state  of  rheumatism.  Hence  the  prin- 
ciple is  supported  by  practice  in  this  case  also. 

Hemoptysis. 

In  all  cases  of  active  hemorrhage,  the  principle 
laid  down  must  be  our  guide.  But  where  hemop- 
tysis occurs  from  a  strain,  sudden  exertion,  or 
blow,  digitalis  may  be  cautiously  used  with  suc- 
cess, where  the  strength  of  the  constitution  or  ha- 


(    27    ) 

bit  of  body  will  allow  reduction.  Hemoptysis  in 
most  cases  tends  towards  consumption ;  and  where 
it  is  not  accompanied  by  an  inflammatory  state  of 
the  system,  if  the  discharge  of  blood  is  frequent 
or  in  considerable  quantity,  fever  soon  occurs, 
when  digitalis  may  be  safely  used.  In  hemorrhages 
proceeding  from  debility  or  a  want  of  action,  digi- 
talis I  consider  as  a  dangerous  remedy.  A  late 
celebrated  author  (Dr.  James  Currie)  writes  ac- 
cording to  my  ideas  on  the  use  of  the  digitalis  in 
hemorrhage.  He  says,  "  I  have  been  less  anxious 
to  extend  the  use  of  the  cold  affusion  to  the  phleg- 
masia and  hemorrhagic,  because  a  remedy  has 
lately  presented  itself  that  greatly  enlarges  our 
power  over  the  numerous  diseases  which  are  ar- 
ranged under  these  orders — I  mean  the  digitalis 
purpurea.  This  medicine  may  almost  be  said  to 
be  possessed  of  a  charm  for  allaying  inordinate 
action  of  the  heart  and  arteries,  and  in  this  point 
of  view  as  well  as  for  its  efficacy  in  some  kinds 
of  dropsy,  particularly  the  hydrothorax,  its  intro- 
duction into  medicine  is  one  of  the  greatest  bene- 
fits our  science  has  received  in  modern  times."* 

Phthisis  Pulmonalis. 

Digitalis  is  no  doubt  serviceable  at  times,  or  in 
some  of  the  stages  of  pulmonary  consumption.  Its 
indiscriminate  use  in  this  disease  is  generally  laid 
aside.  With  a  due  regard  to  our  principle  for  the 
exhibition  of  the  foxglove,   and  its  combination 

*  SeeCuvrie's  Medical  Reports  on  Water,  vol.  ii.  p.  36.  London.  1805. 


(    28     ) 

with  other  medicines,  consumption  may  be  ren- 
dered less  destructive.  Dr.  Beddoes  has  spoken 
with  raptures  on  the  use  of  digitalis  in  this  dis- 
ease ;  in  his  work  on  consumption  he  says,  "  I 
daily  see  many  patients  in  pulmonary  consumption 
advancing  towards  recovery  with  so  firm  a  pace, 
that  I  hope  consumption  henceforward  will  as  re- 
gularly be  cured  by  foxglove  as  ague  by  Peruvian 
bark."*  The  cure  of  consumption  by  mercury 
or  digitalis  having  failed  with  both  separately,  Dr. 
Currie  recommends  them  in  combination.! 

The  various  stages,  forms,  and  accompanying 
symptoms  of  consumption,  render  various  methods 
of  treatment  necessary.  Hence  an  accurate  know- 
ledge of  the  disease  is  not  so  easily  obtained.  If 
digitalis  is  used  in  consumption,  it  would  be  in- 
dicated in  the  first  or  inflammatory  stage,  and  when 
it  retains,  for  any  length  of  ti,me,  as  it  sometimes 
does,  a  similarity  to  pneumonia,  or  a  continual 
febrile  appearance.  Late  European  authors  have 
been  more  limited  in  their  praise  of  digitalis  in 
this  disease.  Dr.  Reid  speaks  with  apparent  mo- 
desty on  this  subject.  He  says  that  "  digitalis  is 
a  remedy  for  pulmonary  consumption  in  its  earlier 
periods,  which,  under  due  regulations,  and  with 
sufficient  attention  to  other  circumstances  of  re- 
gimen and  diet,  may  be  employed  with  a  prospect 
of  almost  invariable  relief.  "J 


*  Page  270,  8vo.  Bristol.  1799. 

f  See  Appendix  to  Currie's  Reports. 

±  See  John  Reitl  on  Consumption,  p.  244.  London.  8vo.  1806. 


(    29    ) 

Dropsies. 

According  to  nosological  arrangement  digitalis 
would  be  rejected  in  the  cure  of  this  class  of  dis- 
eases, for  though  it  sometimes  has  a  diuretic 
effect,  its  powerful  sedative  operation  would  coun- 
teract its  other  qualities  in  these  cases  of  debility. 
Were  it  not  that  they  sometimes  take  on  a  febrile 
appearance,  digitalis  would  perhaps  be  totally  inad- 
missible. I  am  informed  that  our  celebrated  coun- 
tryman, Dr.  Rush,  in  his  lectures  delivered  in  the 
University  of  Pennsylvania,  always  treats  of  the 
febrile  states  of  dropsies.  It  is  certain  that  these 
complaints  do  sometimes  appear  with  a  consider- 
able degree  of  excitement,  and  here  the  exhibition 
of  our  medicine  would  be  indicated.  Hence  we 
are  enabled  also  to  account  for  the  salutary  ope- 
ration of  powerful  evacuating  remedies  in  dropsies 
after  bleeding,  as  calomel  and  jalap,  practised  by 
Dr.  T.  Sim,*  of  Virginia. 

Let  us  examine  the  different  species  of  dropsy, 
and  observe  how  the  principle  of  our  practice 
will  apply. 

Hydrocephalus. 

We  have  the  testimony  of  Dr.  Quin,  as  before 
observed,  in  favour  of  foxglove  in  the  internal 
dropsy  of  the  brain.  Also  of  Dr.  Rush,f  that 
this  is  a  disease  of  excitement.  Thus  practice 
and  theory  give  to  each  their  mutual  support. 

"  See  Medical  Museum,  vol.  i.  p.  318. 
f  Medical  Inquiries. 


(    30    ) 

Hydrothorax. 

Although  I  am  not  able  to  lay  cases  before  the 
reader  of  the  good  effects  of  digitalis  in  dropsy  of 
the  chest,  yet  I  have  no  doubt  of  the  application 
of  our  rule  in  certain  forms  of  this  disease.  The 
authority  of  Dr.  Currie,  as  before  quoted,  page 
27,  will  serve  as  testimony  on  this  head. 

But  perhaps  the  admission  of  this  remedy  may 
be  extended  still  further  in  hydrothorax.  We 
have  seen  that  it  possesses  a  power  of  lessening  the 
irritability  of  the  system,  which  is  perhaps  the 
consequence  of  its  first  diminishing  the  force  of 
the  circulation.  When  a  serous  effusion  takes 
place  in  the  cavity  of  the  chest,  and  interferes  with 
the  expansion  and  compression  of  the  lungs,  the 
irritation  which  this  produces  being  lessened  by 
digitalis,  will  at  least  give  the  patient  a  better 
chance  of  bearing  the  disease,  while  this  remedy, 
or  some  other  in  combination,  may  effect  a  cure, 
provided  it  be  not  pushed  so  as  to  depress  the  cir- 
culation to  too  great  a  degree. 

Anasarca  and  Ascites. 

In  Dr.  Quin's  work  on  the  dropsy  of  the  brain? 
cases  of  anasarca  are  related  as  cured  by  this  me- 
dicine. Anasarca,  however,  seldom  appears  alone, 
unless  when  symptomatic,  or  a  precursor  of  a 
more  general  affection,  accompanied  by  ascites. 
I  have  not  been  able  to  collect  any  cases  of  ascites 
with  symptoms  of  excitement,  save  those  of  Dr. 
Sim  just  referred  to.    But  I  am  informed  by  my 


(     31     ) 

friend,  Dr.  Samuel  Akerly,  that  he  met  with  more 
than  one  case  while  house  physician  to  the  New- 
York  Hospital,  in  which  bleeding  and  other  de- 
pleting remedies  had  the  most  beneficial  effect. 
In  such  cases  digitalis  would  speedily  promote  a 
cure.  I  here  beg  leave  to  offer  my  acknowledg- 
ments to  the  gentleman  just  named  for  his  good- 
ness in  presenting  me  with  most  of  the  cases  which 
conclude  my  dissertation. 

On  the  subject  of  scrophula  I  can  offer  no  testi- 
mony, as  the  disease  is  not  very  prevalent,  and  our 
knowledge  of  it  so  obscure,  that  cases  are  very 
seldom  presented  to  the  inspection  or  observation 
of  students  or  young  practitioners. 

For  the  employment  of  digitalis  in  the  cases 
which  are  attended  with  febrile  excitement,  the 
general  principle  which  has  been  adopted  will  be  a 
guide,  but  still  there  wants  a  greater  detail  of  ob- 
servation to  ascertain  these  points  with  accuracy. 


SECTION  VI. 

Cases  illustrative  of  the  Principles  defended  in  this 
Dissertation. 

Case  I.— Pneumonia. 

"  Downshire,  a  black  man,  aged  16  years,  was 
received  into  the  New-York  Hospital  on  the  4th 
May,  1807,  and  dismissed  cured  in  June  following 
of  pneumonia.  He  was  received  with  a  violent 
pain  in  the  breast,  cough,  and  expectoration  with- 

5 


(     32    ) 

out  blood.  His  pulse  was  full  and  quickened  j 
skin  hot  and  dry.  A  blister  was  applied  to  the 
breast,  and  an  expectorant  given,  being  first  eva- 
cuated with  sulphat  of  soda.  He  likewise  took, 
four  times  a  day,  the  following  powder : 
$  Sulph.  Soda?,   3j. 

Pulv.  Fol.  Digital,  gr.  j»  m.  ft.  pulv. 
An  attempt  was  unsuccessfully  made  to  bleed 
him.  He  continued  these  powders  and  an  expec- 
torant, till  he  was  very  much  relieved,  and  omitted 
them  for  a  few  days,  when  his  complaint  returned 
as  severe  as  ever.  A  blister  was  again  applied, 
and  the  same  course  continued,  by  which  he  got 
entirely  well." 

Case  2. — Pneumonia. 

The  following  notes  were  taken  of  the  case  as  it 
occurred  in  the  winter  of  1808 : 

"  Feb.  25th,  1808.  Margaret  Thompson,  a  fat 
lusty  woman,  aged  about  46,  was  seized  with  a 
severe  pungent  pain  in  the  side  a  few  days  ago, 
which  affects  her  breathing." 

"  Feb.  26th.  Pain  unabated,  cough  considerable, 
pulse  not  very  full,  skin  but  little  excited,  tongue 
whitish. 

P  Sal.  Glaub.  Ij.  statim  sumendus. 

§t  Sac.  Amnion.  J  ss.  tussis  urgent.  sumend» 

§i  Sulph.  Sodas,  grs.  x. 

Pulv.  FoL  Digital,  gr.  j.  m.  ft.  pulv.  capiat 
talem  ter  in  die. 
.   "  The  disease  soon  yielded  without  trouble  to 
this  treatment," 


{     33     ) 

Case  3. — Hemoptysis. 

"  James  Bridge,  aged  24,  was  received  into  the 
New- York  Hospital  22d  Majr,  1807,  with  hemop- 
tysis. 

"  About  two  weeks  previous  he  was  carrying  a 
burthen  in  a  store,  and  was  suddenly  taken  with  a 
rising  of  blood  from  the  lungs,  which  he  dis- 
charged from  the  mouth  to  the  amount  of  two 
quarts  by  his  own  estimation.  In  the  two  weeks 
previous  to  his  coming  to  the  Hospital  he  had  six 
repeated  discharges  of  blood,  which  reduced  him 
to  a  skeleton,  and  rendered  him  hardly  able  to 
walk. 

"  He  had  been  bled,  and  had  a  blister  on  his 
breast  discharging  when  received*  A  teaspoonfu! 
of  salt  was  immediately  given  him  (according  to 
Dr.  Rush's  prescription)  and  he  was  sent  to  the 
ward. 

"  Upon  examining  his  pulse  after  resting,  it  was 
found  small  and  quickened.  The  following  pre- 
scription was  then  ordered,  to  be  taken  three  times 
a  day: 

§2  Muri.  Sodse,   3j. 

Pulv.  Fol.  Digital,  grs.  ij.  m.  ft.  pulv. 
*'  May  23d.  Had  a  small  discharge  of  blood  this 
morning.    Has  taken  two  doses  of  his  medicine. 

"  May  25th.  Feels  better,  pulse  not  so  quick, 
a  or  small. 

"  31st.  Has  taken  his  medicines  regularly,  and 
had  no  discharge  since  the  23d,  except  a  small  one 
to-day. 


(     34    ) 

"  June  1st.  Has  a  considerable  cough.  Dis^ 
charged  to-day  a  quart  or  more  of  blood.  Repeat 
the  salt  and  digitalis  four  times  a  day. 

"  2d.    Cough  continues. 
£  Ol.  Amyg.  dul.  S  j. 
Muc.  Gum.  Arab.  fvj. 
Tinct.  Opii  Camph.  I  ss.  m.  Sumat  coch- 
lar.  un.  par  v.  frequenter  in  die. 

"  3d.  Cough  continues.  Had  a  small  discharge 
to-day. 

"  4th.  Still  coughs.  No  discharge  of  blood  to- 
day. Repeat  medicine.  Apply  a  blister  to  the 
breast. 

"  June  11th.  With  the  expectorant  emulsion 
prescribed  on  the  2d,  his  cough  has  abated,  and 
no  discharge  has  taken  place  since  the  3d.  He  has 
continued  the  salt  and  digitalis.  Now  feels  remark- 
ably well,  is  stronger,  and  feels  an  increasing  ap- 
petite, which  has  been  very  bad  till  within  a  few 
days  past.     Pulse  slow  and  moderately  full. 

"  Afternoon.  Died  with  a  sudden  and  profuse 
discharge  of  blood.  Upon  inquiry  I  find  the  man 
has  eaten  a  very  hearty  meal,  which  was  contrary 
to  the  instructions  given  him.  Besides  his  own 
allowance,  he  eat,  unknown  to  the  nurse,  from  his 
neighbour's  mess :  shortly  after  he  was  seized  with 
a  violent  fit  of  coughing,  which  brought  death  upon 
him  in  a  few  minutes.  An  effort  was  made  to 
bleed  him,  but  too  late,  as  the  discharge,  amount- 
ing to  a  quart  and  a  half  of  arterial  blood,  was  very- 
sudden.  After  standing  a  short  time  it  was  co- 
vered with  a  layer  or  coat  half  an  inch  thick,  being 


(    35    )     ' 

-very  light  in  colour,  and  having  a  fine  spongy  tex- 
ture almost  resembling  the  lungs. 

Examination. 

"  The  abdomen  being  first  opened,  the  stomach 
was  observed  to  be  distended  with  food.  This 
being  opened,  its  contents  measured  34  ounces- 
They  consisted  of  the  natural  secretions,  and  food 
of  various  kinds  undigested,  forming  a  mass  of 
a  blackish  colour.  There  were  several  small  clots 
of  florid  blood  floating  in  it.  The  liver,  spleen, 
and  pancreas  appeared  natural,  but  the  gall-bladder 
was  collapsed,  containing  no  bile,  and  the  kidnies 
were  full  of  small  hydatids. 

"  The  disease  which  was  the  immediate  cause 
of  the  man's  death  existed  in  the  left  lung,  which 
was  very  small,  its  substance  destroyed,  and  firmly 
adhered  on  all  sides.  There  was  a  small  calculus 
in  the  lung. 

"  The  right  lung  was  of  its  natural  colour,  but 
full  of  tuburcles.  It  appeared  to  be  preternaturally 
large,  and  divided  into  two  lobes  nearly  in  the 
middle,  the  superior  part  being  subdivided  into 
four  smaller  lobules.  The  heart  was  situated  far 
in  the  left  side  of  the  chest,  so  that  the  pericar- 
dium adhered  to  the  ribs  some  distance  behind  the 
cartilages. 

Observations. 

"  This  disease  appears  to  have  been  induced  by 
a  malconformation  of  the  lungs,  which,  if  pre- 


*    {    36    ) 

viously  known,  would  have  given  little  hopes  of 
recovery.  After  the  hemoptysis  had  commenced, 
the  man  must  inevitably  have  died  in  a  short  time, 
but  his  life  might  have  been  protracted  some  time 
longer  but  for  his  own  indiscretion.  The  clots  of 
blood  found  in  the  stomach  must  have  been  swal- 
lowed in  his  last  moments,  when  almost  exhausted 
and  gasping  for  breath." 

Case  4. — Rheumatismus  Acutus. 

"  Margaret  Fenton,  aged  26  years,  was  received 
into  the  New- York  Hospital  May  1st,  1807,  with 
acute  rheumatism. 

"  She  was  affected  with  violent  pains  in  the 
body,  limbs,  and  head,  with  stiffness,  and  the 
greatest  pain  on  moving.  Her  pulse  was  full,  hard, 
and  tense,  skin  hot  and  very  dry. 

"  A  saline  cathartic  was  given  her,  and  four 
grains  of  digitalis  ordered  in  pills  of  one  grain  each, 
and,  at  the  same  time,  a  soap  liniment  to  rub  her 
body  and  limbs.  In  the  course  of  the  first  week 
she  was  bled  twice,  each  time  to  the  amount  of 
twelve  ounces. 

"  The  treatment  with  digitalis  and  soap  liniment 
was  continued  to  nearly  the  end  of  the  month, 
when  she  was  completely  cured,  but  remained  in 
the'house  for  amenorrhcea,  of  which  she  complained 
before  she  was  taken  with  rheumatism." 

Case  5. — Rheumatism  us  Acutus. 

"  Joseph  Daily,  aged  28  years,  was  received  into 


(    37    ) 

the  New- York  Hospital  in  the  early  part  of  June, 
1807,  with  acute  rheumatism,  and  discharged  cured 
on  the  22d  of  the  same  month. 

"  He  was  affected  with  violent  pains  in  all  his 
limbs,  and  swelling  of  the  joints,  attended  by  a  full 
and  hard  pulse,  a  hot  and  dry  skin.  He  was 
brought  in  a  carriage,  and  unable  to  move  himself 
when  received  into  the  hospital. 

"  After  being  admitted  he  was  bled  f  xiv.  and 
ordered  the  use  of  the  tincture  of  capsicum  ex- 
ternally. In  the  evening  he  was  placed  in  a  warm 
bath,  and  on  coming  out  a  scruple  of  Dover's 
powder  was  given  him.  One  grain  of  digitalis  in 
pill  was  prescribed  to  be  taken  four  times  a  day. 

"  The  digitalis  and  tincture  of  capsicum  were 
used  till  he  was  discharged  cured  on  the  22d  June, 
1807." 

Case  6. — Rheumatismus  Acutus. 

"  In  January,  1808,  George  Jackson,  a  black 
man,  aged  50  years,  had  application  made  for  him 
at  the  City  Dispensary  for  medical  assistance. 

"  I  found  him  (says  Dr.  Akerly)  in  bed,  tor- 
mented with  excruciating  pain,  which  had  in- 
creased for  several  days  previous  to  my  seeing  him. 
His  pulse  was  full  and  hard,  tongue  white,  skin 
very  hot,  and  both  hands  considerably  swollen, 
which  could  not  be  moved  without  pain,  bowels 
costive. 

"  Besides  these,  he  had  other  accidental  symp- 
toms, which  were  increased  by  the  complaint,  not 
being  part  of  it,    About  a  year  before  he  had  re- 


(  m :) 

ceived  a  violent  blow  on  the  side  and  another  on  the 
head.  There  had  been  an  occasional  pain  in  these 
places,  but  now  it  was  very  much  increased. ,  His 
urine  was  also  bloody,  the  blow  on  the  side  being 
received  about  the  region  of  the  kidney. 

"  From  this  violent  febrile  state  of  disease  he 
had  a  rapid  convalescence,  for  which,  however,  he 
was  not  bled.    I  ordered  him  a  cathartic,  and  the 
following  powders  and  embrocation : 
$t  Sulph.  Sodas,    3  ss. 

Pulv.  Fol.  Digital,  gr.  j.  m.  ft.  pulv.  ter  in 
die  sumend. 
|t  Spt.  Camph.'  2iij« 

Tinct.  Dpii,   3j.  m.  the  pained  parts  were 
rubbed  with  this,  and  a  blister  applied  to  the  side. 

"  Not  getting  better  in  a  few  days,  and  his  bowels 
continuing  costive,  I  prescribed  ten  grains  of  ca- 
lomel, which  he  took  for  four  days  successively,  till 
his  bowels  yielded,  taking  one  powder  less  of  the 
digitalis  and  salt. 

"  He  thence  continued  them  and  his  embroca- 
tion, and  in  a  few  days  was  free  from  fever  and 
pain.  The  swelling  of  his  hands  disappeared,  and 
he  began  to  convalesce,  his  pulse  becoming  mode- 
rate and  soft." 


THE  END. 


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